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A new clinical trial found that performing cognitive behavioral sleep training to teach you how to break bad habits and prepare your body and mind for a good night’s sleep may help prevent depression in elderly people with insomnia.

"What is exciting about these findings is that they are the first to demonstrate that treating insomnia with behavioral strategies rather than medications can prevent depression in the elderly," said sleep expert Wendy Troxel. RAND Corporation, who did not participate in this research.

The results of the study are "very important" because major depression is very common in the elderly and is "related to increased risk of cognitive decline, disability, suicide, and all-cause death," Troxel added.

A large number of studies have shown that insomnia is the main risk factor for depression. "About 30% to 50% of older people complain of insomnia," said the study author, Dr. Michael Owen, professor of psychiatry and biological behavioral sciences at David Geffen College. Doctor of Medicine, University of California, Los Angeles.

Irving said that in a randomized clinical trial, adults who received cognitive behavioral therapy for insomnia were twice as likely to suffer from depression, adding that if the relief of insomnia lasted for three years, “the likelihood of depression would be reduced by 83%. %. Frustrated."

"That's why this research is so important," Irving said. "We have shown that we can actually treat insomnia and prevent depression through cognitive behavioral therapy."

The study, published in JAMA Psychiatry on Wednesday, randomly divided adults over 60 years of age with insomnia but no depression into two groups. For two consecutive months, the control group received eight weeks of basic sleep education every week, teaching sleep hygiene, the characteristics of healthy sleep, sleep biology, and how stress affects sleep. But there is no one-on-one training, Irving said: "They have to get this information and figure out how to use it without our help."

The other group received a behavioral sleep training called CBT-1, which was performed by a well-trained therapist in a small group environment for eight weeks.

"The benefit of this treatment is that it uses the most evidence-based behavioral treatment for insomnia, CBT-I. It has been shown to be as effective, last longer, and (have) fewer side effects compared to sleep medications- It can be particularly problematic in older people," Troxel said.

CBT-I has five components: stimulation control, sleep restriction, sleep hygiene, relaxation and cognitive behavioral therapy. Sleep hygiene and relaxation include good sleep habits-go to bed and wake up at the same time every day, eliminate blue light and noise, take a hot bath or do yoga to relax, keep the bedroom cool, without electronic devices.

Stimulus control involves “getting people up when they can’t fall asleep,” Irving said. He explained that most people stayed in bed, worried about not being able to sleep, and then turned the bed into a negative space. Instead, people are taught to get up after 10 minutes of tossing and turning, engage in quiet, non-irritating activities, and “do not go back to bed until sleepy”.

Sleep restriction includes limiting the time in bed to a person's sleep time plus 30 minutes. This is another way to get insomniacs to wake up instead of lying in bed.

Irving said that cognitive therapy can break "thoughts and beliefs about sleep dysfunction," such as "I can never fall asleep" or "If I don't sleep tonight, I might die." The therapist will work with the patient to fight against this illogical idea, restore them to a more realistic mindset, relax them, and treat the bed as a popular place.

"I really think the team environment is also very important," Irving said, "because hearing about other people's difficulties and how they solve them can usually help you understand what you might be dealing with."

Two months later, the treatment ended without further intervention. However, the study followed these 291 people for three years, and they were checked every month to ask about symptoms of depression.

Irving said that the group of people who received CBT-I training with the help of a sleep coach often continued to receive training in their own lives, and achieved good results: “About one-third of the people still No insomnia.-One year of study."

The sleep-educated group did show "moderate effects in improving and treating insomnia, but (improvement) was not lasting. They did not last," Irving said.

"This is why CBT-I is so effective for people, because the therapist is helping that person navigate and negotiate with themselves-it's really hard," Owen added. "I believe this is also the reason why CBT-I applications or online tools usually don't work-people are frustrated, disappointed or angry with themselves, and they basically stopped working."

Pim Cuijpers, professor of clinical psychology at the Vrije Universiteit Amsterdam and Dr. Charles Reynolds, professor of geriatric psychiatry at the University of Amsterdam, wrote that the results of the study showed "a new and innovative approach" to the growing problem of depression. Pennsylvania Medical Center, in an editorial published with the study.

"The stigma associated with major depression as a mental disorder is one of the main reasons not to seek treatment," writes Cuijpers and Reynolds, who were not involved in the study.

"This major discovery provides exciting new opportunities in the field of prevention and opens up new areas for research on indirect prevention interventions to avoid the stigma of mental disorders."

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